老年椎体压缩性骨折患者椎体强化治疗的疗效和并发症探讨

Efficacy of enhancement treatment on osteoporotic vertebral compression fracture and its complications in the elderly

目的 探讨老年患者骨质疏松性椎体压缩性骨折（OVCF）椎体强化治疗的疗效和并发症. 方法 回顾性分析我院骨科2007年9月至2012年2月期间收治采用椎体成形术（PVP）或球囊扩张后凸成形术（PKP）治疗的OVCF患者183例,其中获得完整随访157例,累及182个椎体,PKP组96例,107个椎体;PVP组61例,75个椎体.术前、术后3d和术后3个月对患者进行视觉模拟评分（VAS）和Oswestry功能障碍指数评分（ODD和随访结束再次行ODI.术后拍摄X线片,测量椎体高度恢复情况,术中监测骨水泥渗漏情况,术后随访是否有再骨折发生. 结果 PVP组术前椎体高度为（1.31±0.18）cm,PKP组为（1.32±0.16）cm;两组比较（t=0.72,P＞0.05）.PVP组术后椎体高度平均为（1.50±0.20）cm,PKP组为（1.66±0.17）cm,两组比较（t=2.28,P＜0.05）.PVP组注入骨水泥量为（2.93±0.34）ml,PKP组为（3.34±0.49）ml,两组比较（t=2.39,P＜0.05）.PVP组术前VAS为（7.5±0.8）分,术后3d为（3.0±0.6）分,术后3个月为（1.9±0.9）分,术前和术后3dVAS评分差异有统计学意义（t=15.59,P＜0.05）.PKP组术前VAS为（7.3±1.0）分,术后3d为（3.0±0.8）分,术后3个月为（2.2±0.9）分,术前和术后3 d VAS差异有统计学意义（t=10.69,P＜0.05）.PVP组术前ODI为（78.9±7.3）分,术后3个月为（30.0±3.7）分,随访结束时为（25.5±3.5）分,术前和术后3个月ODI评分差异有统计学意义（t=20.83,P＜0.01）,术后3个月和随访结束时ODI差异有统计学意义（t=4.03,P＜0.05）.PKP组术前ODI为（78.8±6.8）分,术后3个月为（29.8±4.4）分,随访结束时为（23.8±2.7）分,术前和术后3个月ODI比较（t=21.52,P＜0.01）,术后3个月和随访结束时ODI比较（t=3.14,P＜0.05）.PVP组骨折再发生率为8.2％,PKP组为9.4％（x2=0.06,P＞0.05）.所有渗漏均为无症状渗漏,PVP组发生渗漏15例（20.0％）高于PKP组10例（9.3％）（x2=4.22,P＜0.05）. 结论 椎体强化治疗OVCF能迅速镇痛,短期内改善患者生活质量,PKP、PVP两种手术方式在镇痛和改善患者生活质量方面效果无差别,但PKP在恢复椎体高度和降低骨水泥渗漏率方面有优势.

Objective To investigate the efficacy of the enhancement treatment on osteoporotic vertebral compression fracture and its complications in the elderly.Methods From September 2007 to February 2012,183 patients with osteoporotic vertebral compression fracture underwent percutaneous kyphoplasty （PKP） or percutaneous vertebroplasty （PVP） in our department.157 of them were completely followed up （PKP group,n=96; PVP group,n=61） and totally 182 vertebral bodies were fractured （PKP group,n=107; PVP group,n=75）.Visual analogue scale （VAS） score and Oswestry disability index （ODI） score were evaluated before and 3 days and 3 months after the surgery.Plain film radiography was taken to evaluate the vertebral body height.ODI score was evaluated at the end of the follow-up.The leakage of polymethylmethacrylate （PMMA） during the operation and the refracture were recorded.Results The mean height of the vertebral body before operation had no difference between PVP and PKP group [（1.31±0.18） cm vs.（1.32±0.16） cm,t =0.72,P＞0.05].After the operation,the mean height of the vertebral body was lower in PVP group than in PKP group [（1.50±0.20） cm vs.（1.66±0.17） cm,t=2.28,P＜0.05].The mean amount of the PMMA injected into the vertebral bodies was less in PVP group than in PKP group [（2.93±0.34） ml vs.（3.34±0.49） ml,t=2.39,P＜0.05].In the PVP group,the VAS scores were （7.5±0.79）,（3.0±0.6） and （1.9±0.9） before,3 days and 3 months after operation respectively,and there was a significant difference in VAS score before versus 3 days after operation （t =15.59,P＜0.05）.In thePKPgroup,the VAS scores were （7.3±1.0）,（3.0±0.8） and （2.2± 0.9）before,3 days and 3 months after operation respectively,and there was a significant difference in VAS score before versus 3 days after operation （t=10.69,P＜0.05）.In the PVP group,the ODI scores were （78.9±7.3）,（30.0±3.7） and （25.5±3.5） before and 3 months after operation and at the end of follow-up respectively,and there were significant differences in ODI score before operation versus 3 months after operation （t=20.83,P＜0.01） and 3 months after operation versus at the end of follow-up （t=4.03,P＜0.05）.In the PKP group,the ODI scores were （78.8±6.8）,（29.8±4.43） and （23.8 ± 2.7） before operation,3 months after operation and at the end of follow-up respectively,and there were significant differences in ODI score before operation versus 3 months after operation （t=21.52,P＜0.01） and 3 months after operation versus at the end of follow-up （t=3.14,P＜0.05）.There were no significant differences in VAS and ODI scores between the two groups before versus after operation （t=0.34,P＞0.05）.The incidence of refracture was 8.2％ in PVP group and 9.4％ in PKP group,which had no statistical difference between the two groups（x2 =0.06,P＞0.05）.All the leakage was asymptomatic.The incidence of PMMA leakage was 20.0％ （15 cases） in PVP group and 9.3％ （10 cases） in PKP group,which had a statistical difference between the two groups （x2 =4.22,P ＜ 0.05）.Conclusions Enhancement treatment for osteoporotic vertebral compression fracture can quickly relieve the pain and improve the quality of life.PKP and PVP show no differences in the effect of analgesia and the improvement of life quality,but PKP has the advantages in recovering vertebral height and reducing PMMA leakage.